In the performance year 2022, in order to avoid the penalty, the physicians will have to score a total of 75 overall MIPS points. There are some changes in the MIPS Measure 2022 performance adjustment. Spend a few minutes learning about all of this year’s MIPS payment adjustments.
What Is MIPS Payment Adjustment?
QPP MIPS Payment Adjustment is applied to the Medicare-paid amount for all the professionally covered services that can be performed by MIPS-eligible clinicians.
MIPS Consulting Payment Adjustment for The Performance Year 2022
The merit-Based Incentive Payment System (MIPS) Payment Adjustment file for the performance year 2022 was uploaded to the Health Plan Management System (HPMS) by the Centers for Medicare and Medicaid Services (CMS). This information can be used in the form of a file by Medicare Advantage Organizations (MAOs) to determine the amount of MIPS payment adjustment that is applied the payment to the MIPS-eligible clinician’s performance services under Medicare Part B.
Who Will Receive the QPP MIPS Measure 2022 Payment Adjustment?
All the MIPS-eligible clinicians that are identified by NPI/TIN combination for the 2020 performance year will receive the Mips Measure 2022 payment adjustment in 2022. You will only receive your payment adjustment for the 2020 performance year in 2022 if you:
- A type of clinician that was included in MIPS
- Get enrolled as a Medicare Provider on January 1stYou were a partially qualifying APM participant (Partial QP) who was elected as a MIPS eligible clinician to participate in MIPS.
- Furthermore, if you were not identified as a qualifying alternative payment model (APM) and (QP) participant,
- And if you met one of the following criteria
1. Individually exceeded the Low-Volume Threshold
2. Were opt-in candidates eligible for MIPS and decided to opt in as an individual or group?
3. We’re a member of an authorized online group
4. Opt-in to MIPS or were in a MIPS APM with an APM Entity group that exceeds the low-volume criterion
A single physician who submitted Medicare claims under various TINs in 2020 and who was identified by an NPI may be awarded a different 2020 MIPS Final Score for each distinct TIN/NPI combination.
For covered professional services provided and billed under each of their TIN/NPI combinations in the 2022 payment year, such physicians may get a separate MIPS payment modification.
Determining Your MIPS Consulting Payment Adjustment
If you have met the above-mentioned criteria, then the Final Score that is associated with your NPI/TIN combination will determine your payment adjustment. Your final score will be compared to the performance threshold to decide whether you will receive a positive, negative, or neutral adjustment to the payment that covered the professional services you perform in the MIPS Consulting 2022 payment year.
- The performance threshold for the MIPS consulting 2022 payment year is 45 points. That means all the eligible clinicians with a 2020 MIPS final score of 45 points or higher will avoid the negative payment adjustment in the MIPS 2022 payment year.
- The additional performance threshold for exceptional performance for the MISP consulting 2022 payment year is 85 points. A MIPS-eligible clinician with a Final Score of 85 points or higher will receive an additional payment adjustment factor for exceptional performance.
All the factor(s) that are determined by the MIPS-eligible clinician’s Final score. Payment Adjustments factors are assigned on a linear scale and are based on an applicable percentage.
How Do the MIPS Consulting 2020 Final Scores Relate to MIPS 2022 Payment Adjustment?
Identification of the Applicable MIPS Consulting Adjustment Percentage
The MIPS login Payment Adjustment file consists of four main data elements. Below are the following:
- National Provider Identifier (NPI)
- Taxpayer Identification Number (TIN)
- MIPS Consulting Adjustment Percentage
- An indication (“Percentage Indicator”) of whether the QPP MIPS Adjustment Percentage is positive (“P”) or negative (“N”)
On a claim-by-claim basis, MIPS payment modifications are applied to payments paid for covered professional services provided by a MIPS-eligible physician.
- The Medicare paid amount—not the “allowed amount”—is the amount to which the payment adjustment is made.
- Payment changes do not affect the amount a patient is required to pay.
QPP MIPS payment adjustments apply only to claims for covered professional services provided by MIPS-eligible doctors and billed and reimbursed on an assignment-related basis2. According to the assignments, all claims for healthcare providers who participate in Medicare and are MIPS eligible are reimbursed. Healthcare practitioners who don’t participate can opt to have their claims paid according to their assignments.